Maybe long-term care isn't such a laggard after all

If we've seen anything this month, it's this: Changing a healthcare system is no easy task. Just ask the White House.

Even getting web pages to do their job can be a challenge, as anyone who has tried to log into healthcare.gov can attest. This $300 million pile of technology, which was meant to allow uninsured Americans purchase coverage, has instead become a laughingstock.

President Obama said there is "no excuse" for the numerous ongoing gaffes that have plagued the site, and has promised fixes. Perhaps the head of a minion or two will roll as well. But some people — particularly Republicans in Washington — are saying we need more than a better Geek Squad. They'd like to see Obamacare itself completely scrapped.

Such a course appears unlikely, at least for now. But what if we were to take another whack at fixing healthcare? How would we proceed?

One possible option appears in the October issue of the Harvard Business Review. The nation's preeminent business management magazine is hardly known for promoting crackpot theories. So you know some serious thought went into this plan.

Essentially, authors Michael E. Porter and Thomas H. Lee call for a more patient-centric approach. They have labeled their strategy the “value agenda.” And they seem to be quite convinced that it will work.

“Organizations that progress rapidly in adopting the value agenda will reap huge benefits, even if regulatory change is slow,” they write. Their tome ends on a similarly promising note:

“Those organizations — large and small, community and academic — that can master the value agenda will be rewarded with financial viability and the only kind of reputation that should matter in health care — excellence in outcomes and pride in the value they deliver.”

You have to admit, that sounds pretty good. So how does it work? Turns out the “value agenda” rests on six interconnected pillars:

1: Establish teams made up of both clinical and nonclinical personnel

2: Measure outcomes and costs for every patient

3: Move to bundled payments for care cycles

4: Integrate care delivery systems

5: Expand geographic reach

6: Build an enabling information technology platform.

Wait a second! This is a fundamentally new strategy? It sure sounds an awful lot like what many long-term care operators are already doing.

For decades, we've been hearing that nursing homes are healthcare laggards. If you want to see how long-term care will look in five years, look at a hospital today, we've been told.

But if the “value agenda” is the true wave of the future, maybe the experts have had it backwards all along.